Waging the War on Scars: Setting the Therapy Scene for Success!

Ms Stephanie  Wicks1, Ms Claire  Toose1

1The Children’s Hospital At Westmead, Westmead, Australia


Optimising the functional recovery after a significant burn injury is the common goal of all therapists rehabilitating burns survivors. Managing these injuries in the paediatric population is especially challenging as the success of the rehabilitation phase will set the scene for the years of growth and development ahead. In June 2017, a 3-year-old female was admitted to a tertiary paediatric burns referral centre with 60% TBSA full thickness circumferential flame burns to the entire upper two thirds of her body, including the head, neck, arms and trunk. This presentation will detail the therapy timeline of this patient’s journey over the course of her 6-month admission to hospital and beyond. The most challenging aspects of managing a child with many competing therapy priorities will be explored and successful strategies learnt from this experience shared. End of range axilla splinting is an approach which has been utilised by the therapy team for over 30 years to manage contractures of the axilla region and was integral in maintaining full shoulder range of movement bilaterally in this patient. From the time of injury, the battle lines are drawn in the war against scarring. As the therapy team rallies, the survivor begins the fight for their life. No two burns survivors are identical and successful therapy must be tailored to meet the needs and circumstances of the individual patient. This was particularly evident in this case, with the key to success being a flexible and constantly evolving therapy program.


Stephanie is a Senior Physiotherapist with over 8 years of experience working in paediatric burns rehabilitation. She has an interest in research and was awarded a 2016 Churchill Fellowship to investigate strategies to improve access to therapy for rural patients.

Axillar Splint Construction: A case of Lost, Found and Improvement.

Mrs Ellen Wilson1, Mrs Rob  Wiedemann1

1Alfred Hospital, Oakleigh, Australia


Splinting of axillar burns to prevent contracture and loss of joint function is challenging in all settings for nurses, allied health and patients.
In 2016 a working group involving Physiotherapy, Occupational Therapy and Burns Clinical Nurse Specialists from the Alfred Hospital ICU set out to improve axillar contracture management.
Key objectives for the project were that the splint design must maintain shoulder abduction at 90 degrees, enable patients to be positioned supine, side lying or seated and fabrication of the final product had to be cost effective, compact, transferable and easily fitted.
The initial prototype was completed in late 2017; unfortunately the prototype failed to meet infection controlled standards and required modifications.
The current prototype is a wedge design, consisting of medium density foam rubber and hospital grade outer vinyl covering. Infection prevention approved this design for use in the clinical area.
As of April 2018, we are awaiting an appropriate patient admission to commence trial of the wedge.

Rob. Wiedemann. Acting Burns Resource Nurse and Ellen Wilson, Burns Resource Nurse, Alfred Hospital ICU.


Burns Resource Nurse in ICU at the Alfred since 2014.

Fighting Axilla Burn Contracture Head On: A Retrospective Review of End of Range Axilla Splinting in the Paediatric Population

Ms Rhianydd Thomas1,2, Ms  Stephanie  Wicks1, Mrs Claire Toose1, Dr Verity Pacey2

1The Children’s Hospital At Westmead, Westmead, Australia, 2Macquarie University, North Ryde, Australia


Burns to the axilla region pose a significant challenge to the treating therapist due to the wide range of movement, difficulty achieving a prolonged end of range stretch and the concavity of the axilla, which greatly increases the potential for joint contracture. Standard clinical care at a major paediatric tertiary hospital involves splinting the axilla at end of range abduction for prolonged periods. Anecdotally, it has been noted that adherence to this splinting regime has resulted in excellent range of movement outcomes with very few adverse events recorded.
The project aims primarily to describe range of movement outcomes resulting from end of range axilla splinting. We also aim to identify the extent of variance to which child and burn injury characteristics can predict axilla contracture and subsequent need for non-surgical or surgical intervention within 1 year post burn.
A retrospective review of all patients requiring management of an axilla burn in a 10 year period has been conducted. Descriptive analysis of data will be performed to describe the population characteristics and outcomes at 3, 6, 9, 12, 18 and 24 months post axilla burn injury. A multiple linear regression analysis will be conducted to predict the extent to which baseline variables affect outcomes and to determine if adherence to splinting in the first 3 months is predictive of range of motion outcomes.


Rhianydd Thomas is a burns physiotherapist at The Children’s Hospital at Westmead. She is currently completing a Master of Research focusing on management of axilla burns.


ANZBA is a not for profit organisation and the peak body for health professionals responsible for the care of the burn injured in Australia and New Zealand. ANZBA encourages higher standards of care through education, performance monitoring and research.

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